1. Supporting students and staff after the shooting in Aurora, CO David J. Schonfeld, MD Daniel Nelson, MD National Center for School Crisis and Bereavement Cincinnati Children’s Hospital Medical Center david.schonfeld@cchmc.orgdavid.schonfeld@cchmc.org and daniel.nelson@cchmcdaniel.nelson@cchmc www.cincinnatichildrens.org/school-crisis 513-803-2222

2. Psychological first aid Provide broadly to those impacted Supportive services to foster normative coping and accelerate natural healing process All staff should understand likely reactions and how to help children cope Anyone that interacts with children can be a potential source of assistance and support – if unprepared, they can be a source of further distress

3. Potential symptoms of adjustment reactions Sleep problems Separation anxiety and school avoidance Anxiety and trauma-related fears Difficulties with concentration Deterioration in academic performance Regression Depression; Avoidance of previously enjoyed activities Substance abuse Somatization

4. Video clip introduction (Clip 1)Clip 1

5. Children’s guilt Thought processes limited by: –Egocentrism –Limited understanding of causality –Magical thinking Results in guilt –Reassure children of lack of responsibility

6. Children’s guilt Thought processes limited by: –Egocentrism –Limited understanding of causality –Magical thinking Results in guilt –Reassure children of lack of responsibility

7. What to expect in schools in absence of intervention ↓ Cognitive functioning and academic achievement (anxiety, ↓ concentration, sleep problems, depression) ↑ Absenteeism (school avoidance) ↑ Suspensions/expulsions (irritability, social regression, substance abuse) → → ↓ Graduation Taking time in schools to help children adjust to disaster and aftermath is essential to promote academic achievement

9. Video clip on additional reactions (Clip 2)Clip 2

10. Parents often underestimate symptoms Children may withhold complaints because of concerns they are abnormal, or to protect parents who are upset Parents may not think professionals are interested or assume “normal reactions to abnormal event” Stigma related to mental illness

11. Factors that adversely affect adjustment Direct victimization or witnessing Exposure to horrific scenes (incl. media) Family crisis/divorce/domestic violence Previous trauma Parental challenges in coping Lack of supportive family communication style Pre-existing mental health problems Lack of community resources and support

12. A B C D E F G H I A = baseline functioning B = event C = vulnerable state D = usual coping mechanisms fail E = helplessness, hopelessness F = improved functioning G = continued impairment H = return to baseline I = post-traumatic growth Adjustment Over Time in Crisis

13. Identification, monitoring and referral Importance of situational awareness over time Observation for behavioral changes Communication through support network –Administrators, mental health and counseling staff, crisis coordinators and facilitators Coordinate communication with family

14. Starting the conversation Creating environment where it’s safe to share feelings and concerns Reassure students of safety (but allow students to express concerns and own their feelings) Open the topic Techniques to manage classroom discussion –Redirect excess personal sharing to private setting –Contain distress –Emphasize coping, adjustment and mastery

15. Maintaining structure with support Setting limits with empathy and understanding Providing safe outlets to explore issues Training and awareness of all staff

16. Being with someone in distress Do not try to “cheer up” survivors Do not encourage to be strong or cover emotions Express feelings and demonstrate empathy Avoid statements such as: “I know exactly what you are going through” (you can’t), “You must be angry” (don’t tell person how to feel), “Both my parents died when I was your age” (don’t compete for sympathy) Allow child/family to be upset and tolerate unpleasant affect, without trying to change it. Accept reactions while suspending judgment – intervene only when safety/health is concern

17. Video clip on grief triggers (Clip 3)Clip 3

18. Support for professional staff Adults are impacted as well as students It can be distressing to witness the distress of others Practical supports Informal supports Employee Assistance Program –Horizon Behavioral Services EAP –Any type of problem with complete confidentiality, 24 hours a day. –Call 1-800-284-1819

19. In closing (Clip 4)Clip 4